Contents
Chapter 1 Introduction ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 1
1 History of anesthesiology ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 2
2 The scope of anesthesiology ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 6
3 Classification of anesthesia 9
4 How to learn anesthesiology well ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 11
Suggested Reading ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 12
Chapter 2 Evaluation before Anesthesia ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 13
1 History ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 13
2 The physical examination ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 16
3 Laboratory studies ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 17
4 Anesthesiologist-patient relationship ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 18
5 Premedication¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 20
6 Delaying surgical procedures ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 21
Suggested Reading ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 22
Chapter 3 Anesthesia Monitoring¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 23
1 Standard monitoring ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 23
2 Respiratory system monitoring ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 23
3 Cardiovascular system monitoring ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 29
4 Depth of anesthesia ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 41
5 Neuromuscular blockade monitoring ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 43
6 Temperature monitoring ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 45
Suggested Reading ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 45
Chapter 4 Local Anesthetics and Regional Anesthesia ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 46
1 Local anesthetics¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 46
2 Anatomy and physiology ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 49
3 Nerve block ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 54
4 Spinal anesthesia ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 59
5 Epidural anesthesia ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 61
6 Combined spinal and epidural anesthesia ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 64
7 Caudal anesthesia ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 64
8 Complications of neuraxial blocks ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 65
Suggested Reading ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 66
Chapter 5 Airway Evaluation and Management ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 69
1 Anatomy ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 69
2 Evaluation of airway ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 69
3 Equipment ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 71
4 Airway management ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 76
Suggested Reading ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 79
Chapter 6 General Anesthesia ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 80
1 Anesthetics for general anesthesia ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 80
2 Administration of general anesthesia ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 95
3 Complications of general anesthesia 103
Suggested Reading 107
Chapter 7 Acid-Base Balance and Fluid Therapy 108
1 Regulation of fluid and electrolytes 109
2 Fluid therapy 121
Suggested Reading 123
Chapter 8 The Postanesthesia Care Unit¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 124
1 Admission to the PACU 124
2 Monitoring 124
3 Complications¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 124
4 Recovery from regional anesthesia ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 142
5 Criteria for discharge¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 142
Suggested Reading 143
Chapter 9 Perioperative Acute Respiratory Failure and Acute
Lung Injury (ALI) / Acute Respiratory Distress Syndrome (ARDS) ¡¡¡¡¡ 144
1 Perioperative respiratory failure ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 145
2 Acute respiratory distress syndrome 155
Suggested Reading 164
Chapter 10 Shock 165
1 Introduction ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡165
2 Classification of shock ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡166
3 Pathophysiology of shock¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 168
4 Diagnosis and management of shock ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 173
5 Patient monitoring ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 177
6 Treatment¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 184
7 Specific shock syndromes ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 191
Suggested Reading 192
Chapter 11 Cardiopulmonary Resuscitation 195
1 Definition and causes of cardiac arrest 195
2 Cardiopulmonary resuscitation (CPR) 197
3 Post resuscitation care 208
4 Prognostication following cardiopulmonary cerebral resuscitation 211
Suggested Reading 211
Chapter 12 Nutritional Aspects 212
1 Fasting and malnutrition 212
2 Metabolic response to surgical and traumatic injury 212
3 The metabolic response to sepsis¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 214
4 Modulation of the stress response (during anesthesia) 215
5 Nutritional support ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 218
6 Special consideration¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 220
Suggested Reading 223
Chapter 13 Pain Management ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 224
1 Definition of pain 224
2 Neural basis of pain 224
3 Classification of pain ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 229
4 Pain assessment ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 231
5 Pain therapy 235
Suggested Reading 239
Appendix 241
Appendix ¢ñ : Inhaled anaesthetic agents¡ªphysical properties ¡¡¡¡¡¡¡¡¡ 241
Appendix ¢ò a: Cardiovascular system¡ªnormal values ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡241
Appendix ¢ò b: Vasoactive infusions¡¡¡¡¡¡¡¡¡¡¡ 243
Appendix ¢ó : Chemical pathology¡ªbiochemical values 244
Appendix ¢ô a: Haematology normal values ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 245
Appendix ¢ô b: Coagulation tests¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 246
Appendix ¢ô c: Coagulation screen ¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 247
Appendix ¢õ a: Fluid balance¡¡¡¡¡¡¡¡¡¡¡ 248
Appendix ¢õ b: Intraoperative fluid requirements¡ªadult ¡¡¡¡¡¡¡¡¡¡¡248
Appendix ¢õ c: Fluid, electrolyte and nutritional requirements ¡¡¡¡¡¡¡¡¡ 249
Appendix ¢õ d: Composition of common intravenous fluids ¡¡¡¡¡¡¡¡¡¡ 249
Appendix ¢ö : Renal function tests¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡¡ 250
Appendix ¢÷ a: Pulmonary function tests ¡¡¡¡¡¡¡¡¡¡¡¡¡¡251
Appendix ¢÷ b: Lung function : adult and neonatal values ¡¡¡¡¡¡¡¡¡¡¡ 252
Appendix ¢ø : Paediatrics ¡¡¡¡¡¡¡¡¡¡252
Appendix ¢ù : Gas flows in ananesthetic breathing systems 253
